作者：冯博，李媛，常立国，赵彩君，左秀婷，肖太星

单位：

1.山东省聊城市第三人民医院神经一科2.山东省聊城市第三人民医院CT/MR室

Units：

Department of Neurology, Liaocheng Third People’s Hospital;CT/MR Room, Liaocheng Third People’s Hospital;

关键词：

脑梗死; 缺血预处理; 肢体远隔; 炎症因子; 脑源性神经营养因子; 预后;

Keywords：

Brain infarction;Ischemic preconditioning;Remote limb;Inflammatory factors;Brain-derived neurotrophic factor;Prognosis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.314

Funds：

山东省医药卫生科技发展计划项目（202003071453）；

摘要：

目的 探讨肢体远隔缺血预适应训练对脑梗死患者炎症因子、脑源性神经营养因子（BDNF）及预后的影响。方法 选取2020年1月至2021年3月聊城市第三人民医院收治的脑梗死患者130例，将2020年1—7月纳入的患者作为对照组（n=55）,2020年8月至2021年3月纳入的患者作为研究组（n=75）。对照组给予常规药物治疗，研究组在对照组基础上给予肢体远隔缺血预适应训练。比较两组治疗前、治疗1个月后、治疗6个月后美国国立卫生研究院卒中量表（NIHSS）评分和治疗前、治疗1个月后脑血流动力学指标[大脑中动脉平均血流速度（Vm）、搏动指数（PI）]、外周血炎症因子[IL-6、CRP、肿瘤坏死因子α(TNF-α)]、BDNF及主要不良心血管事件发生率。结果 治疗方法与时间在NIHSS评分上存在交互作用（P<0.05）；时间、治疗方法在NIHSS评分上主效应均显著（P<0.05）。治疗1、6个月后两组NIHSS评分分别低于本组治疗前，治疗6个月后两组NIHSS评分分别低于本组治疗1个月后，且研究组治疗1、6个月后NIHSS评分低于对照组（P<0.05）。治疗1个月后，两组Vm分别快于本组治疗前，PI分别低于本组治疗前，且研究组Vm快于对照组，PI低于对照组（P<0.05）。治疗1个月后，两组IL-6、CRP、TNF-α分别低于本组治疗前，BDNF分别高于本组治疗前，且研究组IL-6、CRP、TNF-α低于对照组，BDNF高于对照组（P<0.05）。研究组主要不良心血管事件发生率（7.0%）低于对照组（23.1%）（χ2=6.479,P=0.011）。结论肢体远隔缺血预适应训练可有效改善脑梗死患者神经功能、脑血流动力学，同时降低机体炎症因子及不良心血管事件发生风险、升高BDNF。

Abstract：

Objective To investigate the effect of remote limb ischemic preconditioning training on inflammatory factors, brain-derived neurotrophic factor（BDNF） and prognosis of patients with cerebral infarction. Methods A total of 130 patients with cerebral infarction admitted to Liaocheng Third People’s Hospital from January 2020 to March 2021 were selected. Patients enrolled from January to July 2020 were included as the control group（n=55）, and patients enrolled from August 2020 to March 2021 were included as the study group（n=75）. The control group was treated with conventional drugs. On the basis of the control group, the study group was given remote limb ischemia preconditioning training. The score of National Institutes of Health Stroke Scale（NIHSS） scores before treatment, 1 month after treatment and 6 months after treatment, cerebral hemodynamic indexes [mean middle cerebral artery blood flow velocity（Vm）, pulse index（PI） ], peripheral blood inflammatory factors [IL-6, CRP, tumor necrosis factor-α（TNF-α） ], BDNF before treatment and 1 month after treatment and the incidence of major adverse cardiovascular events were compared between the two groups. Results There was an interaction between treatment method and time on NIHSS score（P < 0.05）. The main effects of time and treatment method on NIHSS score were significant（P < 0.05）. The NIHSS scores of the two groups after 1 and 6 months of treatment were lower than those before treatment, the NIHSS scores of the two groups after 6 months of treatment were lower than those after 1 month of treatment respectively, and the NIHSS scores of the study group after 1 and 6 months of treatment were lower than those of the control group（P < 0.05）. After 1 month of treatment, Vm of the two groups was faster than that before treatment, PI was lower than that before treatment respectively, Vm of the study group was faster than that of the control group, PI was lower than that of the control group（P < 0.05）. After 1 month of treatment, the levels of IL-6, CRP and TNF-α in the two groups were lower than those before treatment, and the levels of BDNF were higher than those before treatment respectively, the levels of IL-6, CRP and TNF-α in the study group were lower than those in the control group, and the levels of BDNF were higher than those in the control group（P < 0.05）. The incidence rate of major adverse cardiovascular events in the study group（7.0%） was lower than that in the control group（23.1%）（χ2=6.479, P=0.011）. Conclusion Remote limb ischemic preconditioning training can effectively improve the neurological function and cerebral hemodynamics of patients with cerebral infarction, reduce inflammatory factors and risk of major adverse cardiovasular events and increase BDNF.

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